Universidad Central del Caribe Comorbidity and HIV Risk Behaviors among Hispanic Drug Users Residing in Puerto Rico Oral Presentation Session XV 6/19/2003 Oral Presentation Session XV 6/19/2003

Introduction Puerto Rico has been one of the HIV epicenters of the United States since the middle 1980s, soon after the Island’s first AIDS case was detected in 1981 Puerto Rico ranks fourth in AIDS incidence after Washington, D.C., New York, and Maryland Early in the initial period of the HIV epidemic in Puerto Rico, drug users were identified as the group at highest risk of HIV transmission Puerto Rico has been one of the HIV epicenters of the United States since the middle 1980s, soon after the Island’s first AIDS case was detected in 1981 Puerto Rico ranks fourth in AIDS incidence after Washington, D.C., New York, and Maryland Early in the initial period of the HIV epidemic in Puerto Rico, drug users were identified as the group at highest risk of HIV transmission

Introduction In contrast to the U.S. population, injection drug use has been found to be the most common risk factor for AIDS in Puerto Rico and among Puerto Ricans in the US mainland HIV seroprevalence rates for IDUs in Puerto Rico appear to have followed a downward trend similar to those observed among IDUs in several northeastern U.S. cities In contrast to the U.S. population, injection drug use has been found to be the most common risk factor for AIDS in Puerto Rico and among Puerto Ricans in the US mainland HIV seroprevalence rates for IDUs in Puerto Rico appear to have followed a downward trend similar to those observed among IDUs in several northeastern U.S. cities

Introduction Although AIDS incidence has decreased in the Island, our recent studies continue to show a significantly high prevalence of HIV risk behaviors, especially among young drug injectors In Puerto Rico, as in the U.S., many preventive programs have been conducted since the late 1980s to reduce HIV risk behaviors among drug injectors Although AIDS incidence has decreased in the Island, our recent studies continue to show a significantly high prevalence of HIV risk behaviors, especially among young drug injectors In Puerto Rico, as in the U.S., many preventive programs have been conducted since the late 1980s to reduce HIV risk behaviors among drug injectors

Introduction Previous reports have shown significant associations between mental health conditions and HIV risk behaviors among drug users This study will add to previous studies by providing data specifically related to depression and anxiety and their association with HIV risk behaviors, among Hispanic drug injectors recruited in the Island’s neighborhoods Previous reports have shown significant associations between mental health conditions and HIV risk behaviors among drug users This study will add to previous studies by providing data specifically related to depression and anxiety and their association with HIV risk behaviors, among Hispanic drug injectors recruited in the Island’s neighborhoods

Methods Recruitment Area –North region of Puerto Rico Eligibility Criteria –Had injected in the last 30 days prior to the interview –At least 18 yrs. Old –Were not enrolled in drug abuse treatment during the last 30 days prior to the interview Recruitment Area –North region of Puerto Rico Eligibility Criteria –Had injected in the last 30 days prior to the interview –At least 18 yrs. Old –Were not enrolled in drug abuse treatment during the last 30 days prior to the interview

Methods Sample –557 injection drug users Instrument –Socio demographics –Drug use patterns –HIV risk behaviors –Beck inventory scale for anxiety and depression symptoms Analysis –Frequency distributions –Chi-square test of independence –Logistic regression Sample –557 injection drug users Instrument –Socio demographics –Drug use patterns –HIV risk behaviors –Beck inventory scale for anxiety and depression symptoms Analysis –Frequency distributions –Chi-square test of independence –Logistic regression

Description of the study sample Variables N = 557 n% Gender Males Females Age Less than 25 yrs – 34 yrs. old yrs. old Education < High school High school > High School269.6 TABLE 1

Drug Use and Mental Health Co-morbidity by Socio-demographics drug use Patterns and other Health Related Variables TABLE 2 Comorbidity Drug use only Severe anxiety symptoms Severe depression symptoms Both n (%) conditionsP value Gender Females15 (6.8)5 (10.0)11 (8.3)28 (17.9) Males204 (93.2)45 (90.0)121 (91.7)128 (82.1)0.005 Age Less than 25 yrs. 73 (34.1)21 (43.8)39 (31.0)53 (34.6) 25 – 34 yrs. old 78 (36.4)17 (35.4)38 (30.2)65 (42.5) 35 yrs. old 63 (29.4)10 (20.8)49 (38.9)35 (22.9)0.064 Education < High school 118 (53.9)20 (40.0)89 (67.4)90 (57.7) High school 77 (35.2)20 (40.0)31 (23.5)48 (30.8) > High School 24 (11.0)10 (20.0)12 (9.1)18 (11.5)0.029

Drug Use and Mental Health Co-morbidity by Socio-demographics drug use Patterns and other Health Related Variables TABLE 2-2 Comorbidity Drug use only Severe anxiety symptoms Severe depression symptoms Both conditions n (%) P value Homelessness no196 (89.5)44 (88.0)113 (85.6)117 (75.0) yes23 (10.5)6 (12.0)19 (14.4)39 (25.0)0.001 Daily Frequency of Drug Injection < 3 times 91 (41.9)20 (40.0)42 (31.8)50 (32.1) 3 times  126 (58.1)30 (60.0)90 (68.2)106 (67.9)0.133 Years of Drug Injection < (55.3)34 (68.0)71 (53.8)88 (56.4) 6 – 10 yrs 34 (15.5)5 (10.0)20 (15.2)26 (16.7) 11 – 15 yrs 25 (11.4)3 (6.0)12 (9.1)20 (12.8) 16 yrs  39 (17.8)8 (16.0)29 (22.0)22 (14.1)0.615

Logistic Regression Analyses TABLE 3 Share needles Shared cotton Shared water Backloading ORCIORCIORCIORCI None Anxiety only Depression only Both conditions Adjusted by gender, age, education, drug treatment experience, homeless, frequency of drug use, years of drug injection.

Discussion Data from this study concur with previous studies showing that comorbidity involving various psychiatric conditions has been related to HIV risk behaviors This study shows that among Islander Puerto Rican drug injectors not-in- treatment, those affected by either high depression symptomatology or anxiety are significantly more likely to share needles, cotton, or rinse water, and engage in back loading Data from this study concur with previous studies showing that comorbidity involving various psychiatric conditions has been related to HIV risk behaviors This study shows that among Islander Puerto Rican drug injectors not-in- treatment, those affected by either high depression symptomatology or anxiety are significantly more likely to share needles, cotton, or rinse water, and engage in back loading

Discussion The results from this study of heroin injectors with depression or anxiety suggest that these individuals are clearly in need of special attention The development of interventions tailored to address heroin injection, depression, and anxiety seems necessary in order to reduce HIV risks and to decrease drug injection The results from this study of heroin injectors with depression or anxiety suggest that these individuals are clearly in need of special attention The development of interventions tailored to address heroin injection, depression, and anxiety seems necessary in order to reduce HIV risks and to decrease drug injection